Is preoperative period associated with severity and unexpected death of injured patients needing emergency trauma surgery?

Background Management of bleeding trauma patients is still a difficult challenge. Massive transfusion (MT) requires resources to ensure the safety and timely delivery of blood products. Early prediction of MT need may be useful to shorten the time process of blood product preparation. The primary aim of this study was to assess the accuracy of shock index to predict the need for MT in adult patients with trauma. For the same population, we also assessed the accuracy of SI to predict mortality. Methods This systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. We performed a systematic search on MEDLINE, Scopus, and Web of Science from inception to March 2022. Studies were included if they reported MT or mortality with SI recorded at arrival in the field or the emergency department. The risk of bias was assessed using the QUADAS-2. Results Thirty-five studies were included in the systematic review and meta-analysis, for a total of 670,728 patients. For MT the overall sensibility was 0.68 [0.57; 0.76], the overall specificity was 0.84 [0.79; 0.88] and the AUC was 0.85 [0.81; 0.88]. Positive and Negative Likelihood Ratio (LR+; LR−) were 4.24 [3.18–5.65] and 0.39 [0.29–0.52], respectively. For mortality the overall sensibility was 0.358 [0.238; 0.498] the overall specificity 0.742 [0.656; 0.813] and the AUC 0.553 (confidence region for sensitivity given specificity: [0.4014; 0.6759]; confidence region for specificity given sensitivity: [0.4799; 0.6332]). LR+ and LR− were 1.39 [1.36–1.42] and 0.87 [0.85–0.89], respectively. Conclusions Our study demonstrated that SI may have a limited role as the sole tool to predict the need for MT in adult trauma patients. SI is not accurate to predict mortality but may have a role to identify patients with a low risk of mortality.

show abstract

“…Twenty-six studies have been considered for secondary outcome [ 6 , 17 – 20 , 23 , 24 , 26 – 43 , 49 ].…”

Section: Resultsmentioning

confidence: 99%

Shock index as predictor of massive transfusion and mortality in patients with trauma: a systematic review and meta-analysis

Antolini

Casarotta

Gasparri³

et al. 2023

Crit Care

View full text Add to dashboard Cite

show abstract

“…Prolonged ED times for severely injured trauma patients have been shown to increase mortality. 51 Quick airway control, chest drain insertion, and initiation of blood transfusion can be performed before transport to the OT. More time-consuming procedures, such as placement of central lines or arterial lines, should not be allowed to delay transfer.…”

Section: Ed and Airway Managementmentioning

confidence: 99%

Anaesthesia considerations in penetrating trauma

Sheffy

Chemsian

Grabinsky

2014

British Journal of Anaesthesia

View full text Add to dashboard Cite

Trauma and penetrating injury, mostly in the form of assault and self-inflicted gunshot and stab wounds, is a major contributor to mortality and morbidity in the modern world, specifically among younger populations. While the prevalence of this form of injury is drastically lower in the UK and Europe in comparison with the USA, it is still common enough to necessitate practising anaesthetists to have a good understanding and working knowledge of the principles in treating victims with penetrating injury. This review article aims to cover basic principles of attending to penetrating trauma victims starting at the pre-hospital level and continuing into the emergency department (ED) and the operating theatre. We will highlight major issues with regard to airway control, severe bleeding treatment, and emergency scene and ED procedures. We also suggest a work flow for treating life-threatening penetrating injury and review the major controversies in this field. Our perspective is based on the experience and procedures used at the University of Washington's Harborview Medical Center, the only level 1 trauma centre covering the states of Washington, Alaska, Montana, Idaho, and Wyoming in the USA. This region contains almost 11 000 000 persons over a surface area of more than 2 700 000 km(2).

show abstract

“…Previous studies have shown that rapid patient transfer to a trauma center and rapid initiation of definitive care, such as surgery or transarterial embolization (TAE), strongly influence survival among severely injured patients [4][5][6][7][8][9]. The preoperative time course, such as prehospital length of stay (LOS), emergency department (ED) LOS, and total time to surgery or TAE, is therefore regarded as an important parameter in trauma care [10,11].…”

Section: Introductionmentioning

confidence: 99%

Impact of emergency physician-staffed ambulances on preoperative time course and survival among injured patients requiring emergency surgery or transarterial embolization: A retrospective cohort study at a community emergency department in Japan

et al. 2021

Self Cite

View full text Add to dashboard Cite

Injured patients requiring definitive intervention, such as surgery or transarterial embolization (TAE), are an extremely time-sensitive population. The effect of an emergency physician (EP) patient care delivery system in this important trauma subset remains unclear. We aimed to clarify whether the preoperative time course and mortality among injured patients differ between ambulances staffed by EPs and those staffed by emergency life-saving technicians (ELST). This was a retrospective cohort study at a community emergency department (ED) in Japan. We included all injured patients requiring emergency surgery or TAE who were transported directly from the ED to the operating room from January 2002 to December 2019. The primary exposure was dispatch of an EP-staffed ambulance to the prehospital scene. The primary outcome measures were preoperative time course including prehospital length of stay (LOS), ED LOS, and total time to definitive intervention. The other outcome of interest was in-hospital mortality. One-to-one propensity score matching was performed to compare these outcomes between the groups. Of the 1,020 eligible patients, 353 (34.6%) were transported to the ED by an EP-staffed ambulance. In the propensity score-matched analysis with 295 pairs, the EP group showed a significant increase in median prehospital LOS (71.0 min vs. 41.0 min, P < 0.001) and total time to definitive intervention (189.0 min vs. 177.0 min, P = 0.002) in comparison with the ELST group. Conversely, ED LOS was significantly shorter in the EP group than in the ELST group (120.0 min vs. 131.0 min, P = 0.043). There was no significant difference in mortality between the two groups (8.8% vs.9.8%, P = 0.671). At a community hospital in Japan, EP-staffed ambulances were found to be associated with prolonged prehospital time, delay in definitive treatment, and did not improve survival among injured patients needing definitive hemostatic procedures compared with ELST-staffed ambulances.

show abstract

Is preoperative period associated with severity and unexpected death of injured patients needing emergency trauma surgery?

Cited by 9 publications

References 32 publications

Shock index as predictor of massive transfusion and mortality in patients with trauma: a systematic review and meta-analysis

Shock index as predictor of massive transfusion and mortality in patients with trauma: a systematic review and meta-analysis

Anaesthesia considerations in penetrating trauma

Impact of emergency physician-staffed ambulances on preoperative time course and survival among injured patients requiring emergency surgery or transarterial embolization: A retrospective cohort study at a community emergency department in Japan

Contact Info

Product

Resources

About